United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
CATHERINE D. PERRY, District Judge.
This is an action for judicial review of the Commissioner's decision denying Marcus Eberhart's application for disability insurance benefits under Title II of the Act, 42 U.S.C. §§ 401 et seq., and for supplemental security income (SSI) benefits based on disability under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381, et seq. Sections 205(g) and 1631(c)(3) of the Act, 42 U.S.C. §§ 405(g) and 1383(c)(3), provide for judicial review of a final decision of the Commissioner. Eberhart claims he is disabled because of stents, high blood pressure, diabetes, and high cholesterol. Because I find that the decision denying benefits was supported by substantial evidence, I will affirm the decision of the Commissioner.
Eberhart filed his applications for benefits on August 25, 2009. He alleges disability beginning July 15, 2007. On March 28, 2011, an ALJ issued a decision that Eberhart was not disabled. The Appeals Council of the Social Security Administration (SSA) remanded his case for further consideration and a new decision on September 1, 2011. On March 26, 2012, following a hearing, the ALJ again concluded that Eberhart was not disabled. The Appeals Council denied his request for review on April 9, 2013. Therefore, the decision of the ALJ stands as the final decision of the Commissioner.
Evidence Before the Administrative Law Judge
Application for Benefits
In his application for benefits, Eberhart stated that he was born in 1964 and has a high school education, plus two years of college. (Tr. 193, 245). He is 6'3" tall and weighs 265 pounds. (Tr. 238). Eberhart also completed an Adult Function Report in conjunction with his application for benefits on September 21, 2009. In it, he described his daily activities as taking a shower and medication, then preparing his meals for the day. He states, "I'm also very depression because I'm not able to do what I used to do." His teenage son helps with household chores. Eberhart cleans house, does laundry, and mops and sweeps some, but his chest hurts and he gets short of breath. Eberhart shops, pays bills, and handles money. He reads, goes to church and sporting events, watches movies, and visits friends and family, but he can no longer play sports or lift weights. Eberhart claims his medication causes light headedness. He has trouble lifting, squatting, bending, standing, walking, sitting, kneeling, talking, climbing stairs, seeing, remembering, completing tasks, concentrating, understanding, using his hands, and with sexual activity. Eberhart can walk half a block before needing to rest for 15 minutes. He follows directions and gets along with authority figures, but he does not handle stress well. Eberhart "fear[s] [his] health [will] cause [him] to have heart surgery.. and [he] may die." (Tr. 261-68).
Eberhart was seen at St. Louis ConnectCare cardiology on March 5, 2009, for evaluation. He denied any chest pain or shortness of breath. The clinical impression was coronary artery disease - stable and status post stenting. (Tr. 319-20).
Eberhart was given a radionuclide cardiac stress and rest test on April 1, 2009. The clinical impression was mild to moderate mycardial ischemia on the lateral, inferolateral wall and a 41% ejection fraction of the left ventricle. (Tr. 317). He was also given an exercise stress test, which was positive for ischemia. During the test, Eberhart was given nitroglycerin for elevated ST changes. (Tr. 318).
Eberhart had a follow-up visit at St. Louis ConnectCare on May 7, 2009, to discuss his stress test results. He denied any chest pain or shortness of breath. (Tr. 315).
On June 5, 2009, Eberhart underwent a cardiac catheterization by Alan J, Tiefenbrunn, M.D., for reevaluation of coronary artery disease. It was noted that Eberhart had undergone a bare metal stenting of the left anterior descending coronary artery, the diagonal branch, and circumflex coronary artery in October of 2008. His medical history also included diabetes, elevated lipids, and a positive family history for premature coronary artery disease. Eberhart presented with increasing symptoms of dyspnea on exertion. Dr. Tiefenbrunn found an elevated left ventricular end diastolic pressure, with the left ventricle dilated and thick walled with global hypokinesis and an ejection fraction of 40%. The stented segments of the left anterior descending coronary artery, the diagonal branch, and the circumflex vessel were free of high grade restenosis, but Dr. Tiefenbrunn found new high grade segmental narrowing involving the origin of the circumflex coronary artery and its mid portion. Dr. Tiefenbrunn determined that these lesions were amenable to percutaneous revascularization. (Tr. 370).
Eberhart was admitted to Barnes Jewish Hospital on August 6, 2009, for chest pain and non ST elevation myocardial infarction. Eberhart reported a burning sensation in his chest, lightheadedness, and some shortness of breath while watching television. He had no paroxysmal nocturnal dyspnea, no orthopnea, no sycope, and no palpitations. Eberhart reported that he quit smoking about one year ago. Examination revealed blood pressure of 140/82 and a heart rate of 74. He was noted to be pleasant and overweight, with regular breathing rate and rhythm, clear lungs, a soft, nontender abdomen, and no peripheral edema in his extremities. Eberhart was successfully given two drug eluting stents. His lipids were noted to be within appropriate limits, but he was advised to continue on a statin and try to include his HDL component and drop his LDL component. Eberhart's diabetes was noted to be under control, but his hypertension was still elevated and required continued use of a beta blocker and ace inhibitor. (Tr. 327-29).
While in the hospital, Eberhart underwent a cardiac catheterization. The diagnostic impressions were complex 90% ostial circumflex, 70% mid circumflex, and 99% subtotal occlusion of the distal corcumflex/LPL system, with status-post successful PTCA/stent placement with two drug-eluting Xience V stents. It was recommended that Eberhart take aspirin indefinitely and plavix for at least a year. (Tr. 332-34).
Eberhart was evaluated by the Cardiovascular Division of Washington University's School of Medicine on August 24, 2009. He was noted to have coronary artery disease, hypertension, hyperlipidemia, obesity, and a strong family history of premature coronary artery disease. Eberhart had increased exertional dyspnea, but his chest pain and shortness of breath had markedly improved, with no orthopnea, PND, lightheadedness, syncope, or palpitations since August 6, 2009. Eberhart reported shortness of breath during ambulation and rare nighttime chest symptoms that disappeared as soon as he sat up. Physical examination was normal, with regular heart rate and rhythm and no peripheral edema in his extremities. The clinical impression was stable coronary artery disease with three drug-eluting stents for his significant LAD and circumflux disease, appropriate blood pressures, controlled diabetes, and a significantly decreased LDL. It was also noted that Eberhart had stopped smoking. Diet and exercise strategies were discussed with him, and it was suggested that he try cardiac rehabilitation. (Tr. 354-55).
Eberhart had a follow-up visit with St. Louis ConnectCare cardiology on November 23, 2009. He was noted as having coronary artery disease with multiple stents, dyspnea and fatigue, high blood pressure, obesity, and diabetes, but no angina or congestive heart failure. Eberhart was advised to exercise regularly. (Tr. 427-28).
Eberhart underwent a stress test/rest study by St. Louis ConnectCare on January 27, 2010. The impression was a very minimal, subtle, equivocal degree of myocardial infraction at the distal anterior and posterolateral wall. The ejection fraction of the left ventricle was estimated at 56%, with no hypokinesia, dyskinesia, or akinesia of wall motion of the ventricle. (Tr. 465). During a follow-up visit on February 8, 2010, the results of the stress test were discussed with him. No further testing was ordered, but Eberhart was advised to diet and engage in gradual aerobic exercise. (Tr. 466-67).
Treatment records from Washington University's School of Medicine dated April 23, 2010, indicate that Eberhart enrolled in a study called "Cardiac Risk Markers and Unremitting Depression in Acute Coronary Syndrome." The stated purpose of the study was to determine if treating depression in cardiac patients improved other medical risk markers. (Tr. 459). According to Iris Csik, a licensed clinical social worker, Eberhart participated in the study from April through August of 2010. As part of the study, Eberhart met with Ms. Csik, LCSW, for 13 in-person cognitive behavior therapy sessions. At the time of his enrollment, Eberhart's Beck Depression Inventory score was 36, which Ms. Csik stated was indicative of severe depression. In addition to his therapy sessions, Eberhart was also given antidepressant medication for eight weeks as part of the study treatment. In Ms. Csik's opinion, Eberhart's depression "had not fully remitted" at the conclusion of the study. Therefore, she recommended that Eberhart seek additional treatment for depression from his physician and community resources. (Tr. 472-73).
Eberhart missed his appointment on August 16, 2010, but was seen by Joseph Ruwitch, M.D., on October 26, 2010, for cardiac follow-up and chest pain. Eberhart described having left-sided, dull, achy, chest pain that radiated down his arm. His pain level was three out of 10. Eberhart said he had some sweating, but no nausea or vomiting. Eberhart experienced the pain and shortness of breath during exertion. He also reported an intentional 12 pound weight loss. Upon examination, Eberhart's chest was clear and his heartbeat was regular with no murmur. There was no edema in his extremities. An electrocardiogram revealed normal sinus rhythm. Dr. Ruwitch's assessment was high blood pressure controlled, coronary artery disease status post stents, non-specific dyspnea, diabetes mellitus treated with oral medication, lipid disorder, and disability applicant. Eberhart's anti-depressant prescription was renewed, and Eberhart was "reassured." Dr. Ruwitch recommended against stress scanning and told Eberhart to schedule a six month follow-up visit. (Tr. 582-83).
In connection with his claim for benefits, Eberhart was examined by consultative physician Saul Silvermintz, M.D., on November 23, 2010. Dr. Silvermintz identified Eberhart's chief complaints as heart with six stents, high blood pressure, diabetes, and high cholesterol. Upon examination, Eberhart's lungs were clear, his cardiac rhythm and rate were regular with no thrills, murmurs, or rubs, there was no swelling or edema in his extremeties, and his gait was normal. Eberhart could walk on his heels and toes, and he got on and off the examination table without difficulty. Eberhart had no problem with fine finger movements. Dr. Silvermintz's impression was hypertension controlled with evidence of end organ damage, status post myocardial infarction with stent placement, history of elevated cholesterol, and diabetes mellitus type 2 under fairly good control. (Tr. 479-81).
Dr. Silvermintz also completed a medical source statement of ability to do work-related activities (physical). He indicated that Eberhart could occasionally lift and carry up to 10 pounds, sit for eight hours at a time without interruption, stand for 30 minutes at a time, and walk for 10-15 minutes. Dr. Silvermintz opined that, in an eight hour work day, Eberhart could sit for eight hours, stand for two hours, and walk for one hour. Eberhart could occasionally reach and operate foot controls, frequently handle or finger, continuously feel, and never push or pull. Dr. Silvermintz believed that Eberhart should never crawl or climb stairs, ramps, ladders, or scaffolds, and that he should only occasionally balance, stoop, kneel, or crouch. As for environmental limitations, Eberhart should never be exposed to unprotected heights or extreme cold, and should only occasionally be exposed to extreme heat, moving mechanical parts, humidity, dust, odors, fumes, and pulmonary irritants. Dr. Silvermintz stated that Eberhart could frequently operate a motor vehicle and be exposed to vibrations. Dr. Silvermintz opined that Eberhart could shop, travel without a companion, ambulate without assistive devices, walk a block at a reasonable pace on rough surfaces, use public transportation, climb a few stairs without the use of a hand rail, prepare meals and feed himself, groom himself, and handle paper files. Finally, Dr. Silvermintz indicated that Eberhart's limitations had not lasted or would not last for 12 consecutive months. (Tr. 482-87).
Eberhart was also evaluated by licensed psychologist Summer Johnson in connection with his claim for benefits. Ms. Johnson identified Eberhart's chief complaints as depression and a possible learning disability. Eberhart told her he had problems accepting that he was depressed. He reported mood swings, occasional crying spells while watching the news, and feeling sad on some days for no reason. Eberhart stated that his head hurt and that he felt depressed over bad news or thinking about things he can no longer do or control. Eberhart was no longer interested in working out, socializing, and sexual activity. Eberhart reported trouble sleeping and feelings of guilt and low self-esteem. His appetite decreased and he lost about 30 pounds in two months. Eberhart admitted that he previously had thoughts of self-harm and homicidal ideation. Ms. Johnson noted that Eberhart was currently on an ...